- Wrist:
- exam: flexed & ulnarly deviated
- synovectomy:
- synovectomy is most indicates before joint changes occur;
- flexion deformity:
- 30 deg wrist flexion deformity can be treated by serial splinting & casting;
- wedging cast can also be used to correct the deformity w/caution to avoid subluxation;
- Hand:
- MP synovitis is more often seen in the seropositive child;
- fingers extended, swollen, and radially deviated;
- synovectomy, repositioning of extensor tendon over MP joint, & intrinsic transfer for tightness may be performed.
- swan neck deformity in children: treat w/ splint;
- boutonniere deformity;
- injection of tendon sheaths w/ corticosteroids often improves ROM
- tendon ruptures are rare in children and, unlike those in adults, can be rx'ed by primary repair rather than tendon transfer.
- Shoulder:
- shoulder involvement usually occurs in polyarticular JRA (50%) & in systemic form (80%);
- loss of internal rotation & abduction is common;
- children w/ systemic JRA are likely to have severe shoulder involvement
Juvenile rheumatoid arthritis.